title: SUNCT/SUNA and neurovascular compression: new cases and critical literature review.
abstract: BACKGROUND
  Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache with cranial autonomic symptoms (SUNA) are primary headache syndromes. A growing body of literature has focused on brain magnetic resonance imaging (MRI) evidence of neurovascular compression in these syndromes.
  
  
  OBJECTIVE
  The objective of this article is to assess whether SUNCT is a subset of SUNA or whether the two are separate syndromes and clarify the role of neurovascular compression.
  
  
  METHODS
  We describe three new SUNCT cases with MRI findings of neurovascular compression and critically review published SUNCT/SUNA cases.
  
  
  RESULTS
  We identified 222 published SUNCT/SUNA cases. Our three patients with neurovascular compression added to the 34 cases previously described (16.9%). SUNCT and SUNA share the same clinical features and therapeutic options. At present, there is no available abortive treatment for attacks. Lamotrigine was effective in 64% of patients; topiramate and gabapentin in about one-third of cases. Of the 34 cases with neurovascular compression, seven responded to drug therapies, 16 patients underwent microvascular decompression of the trigeminal nerve (MVD) with effectiveness in 75%.
  
  
  CONCLUSIONS
  We suggest that SUNCT and SUNA should be considered clinical phenotypes of the same syndrome. Brain MRI should always be performed with a dedicated view to exclude neurovascular compression. The high percentage of remission after MVD supports the pathogenetic role of neurovascular compression.
authors.affiliation: IRCCS Institute of Neurological Sciences of Bologna, Headache Centre, Bologna, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Favoni
authors.forename: Daniela
authors.initials: D
authors.lastname: Grimaldi
authors.forename: Giulia
authors.initials: G
authors.lastname: Pierangeli
authors.forename: Pietro
authors.initials: P
authors.lastname: Cortelli
authors.forename: Sabina
authors.initials: S
authors.lastname: Cevoli
mesh_terms: D001158:Arteries / Q000473:pathology; D002531:Cerebellum / Q000098:blood supply; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D061145:Microvascular Decompression Surgery; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000473:pathology* / Q000601:surgery; D050798:SUNCT Syndrome / Q000473:pathology* / Q000601:surgery; D051303:Trigeminal Autonomic Cephalalgias / Q000473:pathology / Q000601:surgery; D014276:Trigeminal Nerve / Q000473:pathology / Q000601:surgery
keywords: SUNA; SUNCT; autonomic; microvascular decompression; neurovascular compression